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Randomized Controlled Trial
. 2007 Apr;22(4):478-84.
doi: 10.1007/s11606-006-0069-0.

Randomized controlled trial of a computer-based, tailored intervention to increase smoking cessation counseling by primary care physicians

Marina Unrod  1 , Meredith Smith, Bonnie Spring, Judith DePue, William Redd, Gary Winkel
Affiliations
Randomized Controlled Trial

Randomized controlled trial of a computer-based, tailored intervention to increase smoking cessation counseling by primary care physicians

Marina Unrod et al. J Gen Intern Med. 2007 Apr.

Abstract

Objective: The primary care visit represents an important venue for intervening with a large population of smokers. However, physician adherence to the Smoking Cessation Clinical Guideline (5As) remains low. We evaluated the effectiveness of a computer-tailored intervention designed to increase smoking cessation counseling by primary care physicians.

Methods: Physicians and their patients were randomized to either intervention or control conditions. In addition to brief smoking cessation training, intervention physicians and patients received a one-page report that characterized the patients' smoking habit and history and offered tailored recommendations. Physician performance of the 5As was assessed via patient exit interviews. Quit rates and smoking behaviors were assessed 6 months postintervention via patient phone interviews. Intervention effects were tested in a sample of 70 physicians and 518 of their patients. Results were analyzed via generalized and mixed linear modeling controlling for clustering.

Measurements and main results: Intervention physicians exceeded controls on "Assess" (OR 5.06; 95% CI 3.22, 7.95), "Advise" (OR 2.79; 95% CI 1.70, 4.59), "Assist-set goals" (OR 4.31; 95% CI 2.59, 7.16), "Assist-provide written materials" (OR 5.14; 95% CI 2.60, 10.14), "Assist-provide referral" (OR 6.48; 95% CI 3.11, 13.49), "Assist-discuss medication" (OR 4.72;95% CI 2.90, 7.68), and "Arrange" (OR 8.14; 95% CI 3.98, 16.68), all p values being < 0.0001. Intervention patients were 1.77 (CI 0.94, 3.34,p = 0.078) times more likely than controls to be abstinent (12 versus 8%), a difference that approached, but did not reach statistical significance, and surpassed controls on number of days quit (18.4 versus 12.2, p < .05) but not on number of quit attempts.

Conclusions: The use of a brief computer-tailored report improved physicians' implementation of the 5As and had a modest effect on patients' smoking behaviors 6 months postintervention.

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Figures

Figure 1
Figure 1
Patient and physician recruitment flowcharts.
Figure 2
Figure 2
Sample expert-system report.
Figure 3
Figure 3
Patient-reported “5A” performance by physicians (n = 518). Ratings are based on patient exit interviews occurring immediately postvisit. All group differences, except “Ask”, are statistically significant.
See this image and copyright information in PMC

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